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MMM Dorado Platino (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MMM Dorado Platino (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MMM Dorado Platino (HMO D-SNP) in 2025, please refer to our full plan details page.
MMM Dorado Platino (HMO D-SNP) is a HMO D-SNP plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Puerto Rico Northwest. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that MMM Dorado Platino (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
MMM Dorado Platino (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about MMM Dorado Platino (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For MMM Dorado Platino (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $100.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The MMM Dorado Platino (HMO D-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for your drugs based on the tier and pharmacy you use until your total drug costs reach $2000. If you qualify for the low-income subsidy (LIS), you may have your premium reduced. Once your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The MMM Dorado Platino (HMO D-SNP) plan offers a range of benefits with varying cost structures. Many services have no copay, including ambulance, emergency, and urgent care, primary care, occupational therapy, physical therapy, speech therapy, dialysis, durable medical equipment, home health, diagnostic and radiological services, and skilled nursing. Other benefits include dental, vision, and hearing coverage, with maximum annual benefits, and transportation services for 12 one-way trips per year. This plan provides additional coverage for preventive services and some other services, such as acupuncture, which has a limit of 6 treatments per year up to $500. It also includes an over-the-counter (OTC) allowance of $35 every three months and a meal benefit for chronic illness. However, the plan has limitations, such as not covering all services, including certain types of hearing aids and vision services, and not offering coverage for cardiac rehabilitation services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization. Additional days, non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute are not covered, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services and observation services, with prior authorization required. Ambulatory Surgical Center (ASC) Services are covered with prior authorization, and Outpatient Substance Abuse Services are covered, but individual and group sessions are not covered. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by MMM Dorado Platino (HMO D-SNP) and requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by MMM Dorado Platino (HMO D-SNP), with no copay or coinsurance for ambulance services. Transportation Services to any health-related location are not covered, while transportation services to a plan-approved health-related location are covered for 12 one-way trips per year, using rideshare services, bus/subway, van, or medical transport.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage have no copay or coinsurance. Worldwide Urgent Coverage has a $75 copay, and Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Chiropractic Services have a maximum plan benefit coverage amount of $750 per year, and Routine Chiropractic Care is limited to 6 visits per year. Occupational Therapy Services, and Physical Therapy and Speech-Language Pathology Services have no copay or coinsurance. Some services are covered but Individual Sessions for Mental Health Specialty Services and Group Sessions for Mental Health Specialty Services are not covered.
Preventive Services See details
Preventive Services are covered by the MMM Dorado Platino (HMO D-SNP) plan, including Medicare-covered preventive services with prior authorization, and additional preventive services like Health Education, Alternative Therapies, Nutritional/Dietary Benefits, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, and Home and Bathroom Safety Devices and Modifications. The plan does not cover Annual Physical Exams, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Enhanced Disease Management, Telemonitoring Services, and Counseling Services.
Hearing Services See details
Hearing Services for the MMM Dorado Platino (HMO D-SNP) plan include coverage for hearing exams and fitting/evaluation for hearing aids, but routine hearing exams are not covered; prescription hearing aids are covered with a maximum plan benefit of $2500 every three years, with coverage for all types of prescription hearing aids except for inner, outer, and over the ear hearing aids; OTC hearing aids are not covered. Fitting/evaluation for hearing aids is limited to one visit per year.
Vision Services See details
Vision services are partially covered by the MMM Dorado Platino (HMO D-SNP) plan, with coverage for eye exams, contact lenses, and eyeglasses (lenses and frames), but not for routine eye exams, eyeglass lenses, eyeglass frames, or upgrades. Eyewear has a combined maximum benefit of $750 per year.
Dental Services See details
Dental Services are covered, with a maximum plan benefit of $1,500 per year. Medicare Dental Services, Orthodontic Services, Restorative Services, Prosthodontics (removable), Implant Services, and Prosthodontics (fixed) are covered. Adjunctive General Services, Endodontics, Periodontics, Maxillofacial Prosthetics, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, but Medicare Part B Chemotherapy/Radiation Drugs are not covered. Prior authorization is required for Home Infusion bundled Services.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. There is no copay or coinsurance for this benefit.
Medical Equipment See details
Medical Equipment is covered by the MMM Dorado Platino (HMO D-SNP) plan, with no copay or coinsurance for Durable Medical Equipment and Prosthetics/Medical Supplies - Non-Medicare benefit. Diabetic Equipment, Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the MMM Dorado Platino (HMO D-SNP) plan, but some services are not covered. There is no copay for diagnostic services and radiological services, but Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the MMM Dorado Platino (HMO D-SNP) plan. There is no copay or coinsurance for this benefit, but authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but not covered in practice, as the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required, but there is no copay.
Other Services See details
Under Other Services, the MMM Dorado Platino (HMO D-SNP) plan covers acupuncture with a limit of 6 treatments per year up to $500 and requires prior authorization and a doctor referral. The plan also covers over-the-counter (OTC) items up to $35 every three months, including nicotine replacement therapy, but does not cover all drugs on the CMS OTC list, and covers a meal benefit for a chronic illness.
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